Inspection on 10/04/06 for Latham Lodge Nursing and Residential Care Home

This inspection was carried out on 10th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Latham Lodge Nursing and... 19/12/08

Latham Lodge Nursing and... 30/06/08

Latham Lodge Nursing and... 03/10/05

Latham Lodge Nursing and... 01/06/05

Latham Lodge Nursing and... 19/08/04

Latham Lodge Nursing and... 13/04/04

Similar services:

St Vincents

The Cotswold Home

Winton House

Newbeech House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Latham Lodge Nursing and Residential Care Home 137 - 139 Stakes Road Purbrook Hampshire PO7 5PD Lead Inspector Isolina Reilly Unannounced Inspection 10th April 2006 09:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Latham Lodge Nursing and Residential Care Home DS0000011509.V287645.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Latham Lodge Nursing and Residential Care Home DS0000011509.V287645.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Latham Lodge Nursing and Residential Care Home 137 - 139 Stakes Road Purbrook Hampshire PO7 5PD Address Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 023 9225 4175 023 9226 2281 latham@caringhomes.org Latham Lodge Limited TO BE CONFIRMED Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability (8), Physical disability of places over 65 years of age (40), Terminally ill (8), Terminally ill over 65 years of age (20) Latham Lodge Nursing and Residential Care Home DS0000011509.V287645.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. All service users must be over 55 years of age Date of last inspection 03/10/05 Brief Description of the Service: Latham Lodge is registered as a care home where nursing care can be provided for up to forty people in the categories of old age, terminal illness or physical disability. The home can also admit up to eight people above the age of 55 in the category of terminal illness and physical disability. The home is owned by Latham Lodge Limited. A senior manager in the organisation is temporarily managing the home whilst one is being recruited. The home has twenty-six single rooms (of which twelve have en-suite bathrooms) and seven shared rooms (one of which is en-suite). The home is located in a residential area. The building is on two floors with a shaft lift to access the first floor. The home has a large car park at the front of the building and a garden accessible to the residents at the rear. The provider makes information available about the service, including the commissions report to prospective residents on request. Copies of this information are available at the home and may be sent out by post on request. The home states in the pre-visit information questionnaire completed by the manager that the fees range from £370 to £450 for residential care and from £460 to £690 for nursing care per week. Latham Lodge Nursing and Residential Care Home DS0000011509.V287645.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit took place over one day. The inspector looked around the home, viewed records and procedures, spoke with residents, relatives, a visiting doctor, staff, the administrator and observed the interaction between them. The manager and area manager helped the inspector during the visit. Information has also been taken from the pre-visit questionnaire filled in by the manager, correspondence with the home and monthly reports on how the service is doing, sent in by the area manager. The commission has received written questionnaires from twelve residents and four visitors. The responses were positive but three residents stated they only sometimes liked the food and meals provided. What the service does well: What has improved since the last inspection? Since the last visit the home has improved its records and information on how to look after each resident, which has improved the way they are looked after. The home has set up a system with a local pharmacy to dispose of unwanted medicines that works well. Latham Lodge Nursing and Residential Care Home DS0000011509.V287645.R01.S.doc Version 5.1 Page 6 Since the last visit, the home has employed a person dedicated to setting up activities for the residents both as individuals and as small and large groups. The residents were all very complimentary of this service and looked forward to the different activities. There has been a considerable amount of refurbishment and redecorating throughout the home. The organisation is making substantial investments by replacing fittings and furniture to improve the quality of the surrounding for residents. The management has increased the number of carers available during the busiest times and purchased a new hoist, which has helped to reduce waiting times for residents at peak times. The staff stated that the new manager has made a big difference to the home and things are now getting done which had previously been left. They also stated that they feel supported and like working at the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Latham Lodge Nursing and Residential Care Home DS0000011509.V287645.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Latham Lodge Nursing and Residential Care Home DS0000011509.V287645.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a good admission process that is well managed and residents are given clear information regarding the service. The home does not provide ‘Intermediate Care’. EVIDENCE: The residents spoken with explained that family members were able to visit the home before making their decision to stay. The manager or the head of nursing care undertakes an interview with the resident and family completing a full assessment of needs and aspirations. Records of these completed assessments were seen on the files. The head of care explained that whilst she had been in post for only three weeks she was in the process of checking all assessments against the current needs of residents. Latham Lodge Nursing and Residential Care Home DS0000011509.V287645.R01.S.doc Version 5.1 Page 9 One out of the four residents records seen had a copy of the Adult Services care management assessment and the instructions to care staff mirror these needs. Another residents file had a copy of a health care assessment prior to admission. The head of care and manager confirmed that all new residents undergo a full assessment of their needs to be met by the home. These cover the necessary areas including, personal care, physical well-being, dietary preferences and records of regular weights. Information was seen on each file that described issues with sight, hearing, mouth and foot care. There was information on the level of mobility and dexterity and a history of falls, continence and behaviour. There was a separate bibliography for each resident that covered key events and relationships in their lives including likes, dislikes and preferences. The relatives spoken with said that the home asked lots of relevant questions and looked after the residents very well. Most residents stated that they were made very welcome and one resident explained, “Staff were very sensitive to my fears and have helped me regain my confidence.” Another resident stated, “This is good place to be as I am unable to be in my own home.” The four residents records seen contained a signed contract that were informative and contained all the necessary information. The residents and relatives spoken with confirmed that the contracts had been explained to them when they first came to the home. The manager and area manager confirmed that the home does not provide ‘intermediate care’ rehabilitative short-term type care for Social Services. Latham Lodge Nursing and Residential Care Home DS0000011509.V287645.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The records of care within the home have improved and hold the necessary details for staff to meet residents’ personal and health care needs, whilst promoting their privacy and dignity. The home has greatly improved the way they store and handle medicines but records still have some gaps in them, which need to be addressed. EVIDENCE: Three out of the four resident files were discussed with each individual resident who confirmed that they recognised the records and the staff have discussed their needs and care with them. The care plans contained written risk assessments and instructions to staff on how to look after the individual. The records also included names of relatives, friends, health care professionals and social services care managers who are involved in supporting the individual. The home is now using the Latham Lodge Nursing and Residential Care Home DS0000011509.V287645.R01.S.doc Version 5.1 Page 11 organisation’s care planning documentation that includes care needs and risk assessments. These are currently being reviewed by the new Head of Care Nurse to ensure that care plans are up to date, relevant and in easier to use for all staff. The manager and nurses spoken with confirmed this. All files seen had been recently reviewed by staff and signed by each resident. There were details of monthly reviews and changes to care instructions recorded. The nurses spoken with all commented that they found the system logical and felt involved in the care planning and recording process. However, the carers found the care plans a little intimidating and relied on handovers and asking the nurses for information. The carers also stated that they informally have additional handover between themselves to ensure that all basic care and housekeeping information about individuals is handed over to the next shift. The Head of Care Nurse is aware of this and this is why she is looking to revise the documentation so that everyone can use it. Records of doctor and nurse visits and information on outpatient, dental, optician and chiropractic appointments were seen on the files. Various residents stated that the visiting dentist and opticians had recently seen them. The recent treatment and the corresponding medical notes were present in the file. The inspector was able to speak with a visiting doctor who confirmed that the home on the whole provides a fair service. He explained that improves have been made following a period of instability at the home due to changes in management and staff. It was noted that one resident had a specific medical condition that was assessed and identified on admission but had not been carried over into the care plan instructions to staff. However, the nurse and carers were all aware of this medical condition and the individual had not required any care with this aspect of his health. It was evident that this had not been a problem for the resident. There were good clear records on wound care and photographs are available on file to visually track the improvement of the wounds. The residents spoken with were all very complimentary of the care provided by the home. Stating that staff are caring, helpful, appear to know what they are doing and look after them well. They also said that the staff are always respectful and mindful of their privacy and dignity. They also stated that they choose and wear their own clothes. The relatives spoken with confirmed this stating that ‘the home does a good job of looking after the residents’. One relative stated that by comparison the service her mother receives at Latham is far superior to that of the previous home. The inspector observed the staff interacting with the residents and found them attentive and professional. There were staff around most of the time in the Latham Lodge Nursing and Residential Care Home DS0000011509.V287645.R01.S.doc Version 5.1 Page 12 communal areas. Refreshments and snacks for both residents and visitors were offered regularly throughout the day. The staff were observed administering medication appropriately and there is a good medication policy and procedures. The home administers from ‘single blister pack system’ provided by the local pharmacist and correctly stores the medication in appropriate cupboard within a locked medical room. The home has one resident who is self administering their own medicines, these were seen to be stored securely but the nurses still had access to them if they needed to. There was an appropriate assessment and agreement recorded signed by the resident. The home’s policy stated that this agreement should be assessed every six months but the nurse spoken with was unclear of the timeframe for this. The nurses’ order and check all medicine received at the home recording name, quantity and sign for them. The records were seen and found to be satisfactory. The home uses the ‘Medicine Administration Record Sheets (MARS) system for recording the administration of medication. Each resident’s record also has a recent photograph. It was noted that there were several signature gaps in the administration records for three at out twenty records seen. Since the last visit, the home has implemented a monitoring and checking system that is done daily, weekly and monthly. The gaps were tracked back with the nurse and found that two out of the five gaps had been picked up by the monitoring system and management had dealt with it. It was noted that agency nurses had been responsible for the omissions. This was discussed with the managers who confirmed that they would look at how they can improve the monitoring of agency nurses when working at the home to ensure that gaps in administration records do not occur. The nurses and carers stated that only the registered nurses administer medicines but some of the carers have received training in the safe handling of medication so they can assist. The home’s medical room and cupboards stored were clean and reasonably orderly with medication stored correctly in date and in sufficient quantities. Since the last visit, the home has implemented a system for disposal and collection of unwanted medicines including detailed records with dates and signatures of all medication. They have also installed a minimum and maximum temperature-reading thermometer for the fridge. This is checked daily in the morning and recorded. These were seen and found to be satisfactory. The manager and nurses spoken with confirmed that they had attended update medication training from the local pharmacy in March 2006. Training records were available from the nurse who is in charge of training at the home. The home has a copy of the Royal Pharmaceutical Guidelines for residential care and a recent ‘British National Formula’ (BNF) pharmaceutical reference book. It was noted that the home has samples of staff signatures and initials. Latham Lodge Nursing and Residential Care Home DS0000011509.V287645.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents experience a stimulating and varied life at the home with visitors made welcome. This has greatly improved with the employment of an activities co-ordinators. The meals in this home are good but the residents are not aware that a choice is available. EVIDENCE: The inspector observed residents reading large print books, daily newspapers, magazines, crosswords and doing a jigsaw puzzle. The residents spoke with were complimentary of the new activities ‘lady’ saying that they missed her when she had a day off. They explained that there is a great variety of group and social activities in the home throughout the week and also they are able to have one to one quality time with her. One resident stated that the co-ordinator came and read to her on a regular basis, which she thoroughly enjoyed. Another resident does jigsaw puzzles and makes pictures for hanging. The co-ordinator was observed setting the part completed jigsaw for the resident to continue with his hobby. This information was recorded in the individual’s activity records. Latham Lodge Nursing and Residential Care Home DS0000011509.V287645.R01.S.doc Version 5.1 Page 14 Four of the residents spoken with suggested that they would enjoy outings and days out. The co-ordinator explained that she was looking into this for when the weather gets better. The co-ordinator has many years experience in providing activities for older people and has set up good recording systems and in the three weeks of her employment has established and recorded all the residents’ likes and dislikes, social and cultural aspirations. She had produced a programme of activities that was advertised on posters around the home. The residents spoken with were aware of what is on and when. The co-ordinator is going round and talking to residents about their lives, relationships and experience. One of the resident’s bibliography held by the co-ordinator had more information on it than the copy held in the care records. This was discussed with the head of care and co-ordinator who are going to work out how to make sure information about individuals is shared across the two areas of work. The residents and relatives confirmed that clergy visit the home regularly. Two residents stated that they had received communion the day before. Information about residents’ religious preferences and cultural aspiration were seen on file. The relatives spoken with feel the clients are very well cared for and that they are made very welcome and part of the home. The inspector observed that relatives visiting that day had been offered refreshments. There were cold drinks available all day in the communal areas, hot drinks, biscuits and cake was taken around regularly throughout the day. All the residents stated that the day routine is flexible and a meal can be put aside should they wish. The inspector observed one resident asking the manager to inform the kitchen she wanted her meal put aside for later as she was going out to a hospital appointment. However, some residents and relatives stated that in the past they have had to wait for a long time to be taken to the toilet during the busy times. They stated that recently this has improved with one extra staff member on the morning shift and the new additional hoist. The inspector was able to speak to kitchen staff and found that there are good system in place for cleaning, hazards and risk assessments. The menus are kept on the fridge door for easy view by staff but there is no advertising of the menu outside the kitchen. Several residents stated that they did not know what was for lunch and would like to be able to look it up for themselves when they feel like. They confirmed that staff come around the day before so they can choose from a wide selection of cooked and continental breakfasts for the next day. The staff check to see if they are happy with the lunch meal for the next day. There was a wipe board in the kitchen where individuals’ likes, dislikes and special diets were listed. The cook explained that the home is investing in a daily card menu that has all the options printed on the card for Latham Lodge Nursing and Residential Care Home DS0000011509.V287645.R01.S.doc Version 5.1 Page 15 each day so residents can select their choice. The managers confirmed this. The inspector viewed the four-week menu and found it to be variable, balanced and with written amendments but there were no alternatives listed except for the lunchtime meal. The records of food provided by the home showed that alternative meals were provided on a regular basis and the kitchen staff were aware of individuals preferences. On feeding this information back to the managers, they stated that as a matter of priority they would speak to the residents and complete a full survey of their views, likes and dislikes and review the home’s meals options, menu planning and advertising. A member of staff suggested that the home was not providing sufficient meat with the main meal. It was also suggested in response to the CSCI surveys that three residents did not like the food. The inspector spoke to twenty-two residents all who stated that the quantity of food was generous including the meat, although there were individual preferences on how the meat and vegetables are cooked and type of meat cuts. They felt the food was fine and of good quality. The residents were very happy with mealtime experiences and felt they were not rushed. The meal was observed by the inspector and found to be relaxed, unhurried and the food attractively presented. This was also reflected in the responses seen on the residents’ written comment cards. Daily records of foods served and temperatures of hot probed meals and freezers and fridges are kept by the cooks and found to be satisfactory. Latham Lodge Nursing and Residential Care Home DS0000011509.V287645.R01.S.doc Version 5.1 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents, relatives and staff are confident that their complaints will be listened to, taken seriously and acted upon. Staff have a good understanding of Adult Protection issues that protects residents from potential abuse. EVIDENCE: It was noted from the sixteen resident and relatives comment cards received by the commission that all stated they had not had reason to complain about the service received. The residents and relatives have spoken with stated that they would go straight to the manager or senior nurse if they had a concern or complaint. They confirmed that the staff are good and always listen to their concerns. The relative felt that the staff were patient, caring and willing to listen and the inspector observed this during the day. The staff spoken with were aware of the home’s complaint procedure. The home’s complaint procedure includes the address for the Commission and that all complaints will be dealt within 28 days. A copy of the home’s complaint procedure is displayed in reception. The home has received three complaints in the last twelve months, which were resolved promptly. One complaint identified that the home had insufficient hoists and some residents were having to wait a long time to go to the toilet as a response the home purchased an additional hoist. The complaint log was Latham Lodge Nursing and Residential Care Home DS0000011509.V287645.R01.S.doc Version 5.1 Page 17 seen and found to be satisfactory. The manager confirmed that detailed records of each complaint are stored separately. All the residents spoken with stated that they always felt safe at the home and the relative also confirmed this. The staff spoken with confirmed that they have received instruction and are aware of the protection of vulnerable adults from abuse. They have attended training on recognising and reporting of concerns or suspicions. There have been two allegations of abuse at this home. Each allegation was promptly and appropriate reported and records kept. The home has an up to date copy of the Hampshire County Council ‘Protection of Vulnerable Adults’ policy and procedure and it’s own policy and procedures reflecting the guidelines from Hampshire County council’s own policy. All the staff spoken with stated that there was an open and encouraging ethos to speaking up when things are not quiet right and issues being dealt with professionally. Latham Lodge Nursing and Residential Care Home DS0000011509.V287645.R01.S.doc Version 5.1 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home presents as a clean, homely, comfortable and suitable environment for the residents. The standard of the décor within the home is good with evidence of on-going maintenance and improvements. EVIDENCE: The residents stated that the home is always clean, warm and no offensive odours were detected. They also confirmed that there has been on going decorating including the entrance, hallways and bedrooms. The manger confirmed that there has been substantial redecorating and refurbishment throughout the home and are on target to meet their plan for improving the quality of the environment. Since the last visit, the main reception, main lounge and ten bedrooms have been fully refurbished, Latham Lodge Nursing and Residential Care Home DS0000011509.V287645.R01.S.doc Version 5.1 Page 19 decorated and new carpets fitted. The home has a programme of redecorating and refurbishment of bedrooms as they become vacant. All the residents spoken to like their bedrooms. The home’s radiators and pipe work are safe ensuring that potential hot surfaces are kept to low temperature. A random selection of the bedrooms where seen on a tour around the home and were found to be clean, bright and warm, furnished to the individuals taste and most had been personalise. The managers confirmed that new dining room furniture has been orders and will arrive soon. The new dining room carpet was delivered on the day of the visit ready for fitting. The large activity room has had a hairdressing facility fitted in one corner. At the last visit it was found that from the lounge, residents could go out into the garden but not get back in as the French doors where fitted with a secure fire exit type locking system. The manager confirmed that the lounge French doors leading to the garden have not been changed yet because the ramps had to be built first. This has now been done and they are looking at what is the best locking system for the patio doors. The manager stated that in the mean time staff would help residents to go in and out as they wish. All residents’ spoken with felt there were enough toilets and bathrooms. One bathroom has been fully refurbished and the manager confirmed that other bathrooms are on schedule to refurbish. Some will be converted into fully accessible showers to provide choice for the residents. During the tour of the home, the inspector noted that all the communal hand sinks had liquid soap for washing hands and disposable paper towels, which promoted a good hand hygiene. There were gloves and plastic aprons available in different places around the home, including the laundry, toilets and bathrooms. The residents and relatives stated that the staff do use them. The staff confirmed that they have received regular training on infection control. The laundry room is large and accessed from outside the house via a covered walkway. There are two industrial size washing machines and two industrial tumble dryers all were seen working. An old tumble dryer had been removed and was left to one side in front of the hand-washing sink. This was due to the machine being too big in size to get out the door. It was noted that there was no separate sink for hand washing clothes. This was discussed with the managers who stated they were planning to fit an additional sink next to the hand-washing sink that could be used for sluicing or hand washing clothes. However, currently there is no demand for hand washing clothes and soiled articles are placed directly into the washing machine from red linen bags with minimum handling to prevent spread of infection. The washing machines have proper sluicing programmes that meet the infection control standards and clean the articles without need for hand sluicing. The inspector observed the laundry staff taking laundered clothing around to residents. The clothing was clean well presented and looked well looked after. The residents and relatives Latham Lodge Nursing and Residential Care Home DS0000011509.V287645.R01.S.doc Version 5.1 Page 20 spoken with stated that they were happy with the laundry service provided. An old rotary iron identified as broken at the last visit, remains broken. The managers stated that the replacement of the machine is on the maintenance list but is not high priority at present because there are other ironing facilities in the laundry room and residents are not affected while waiting for its replacement. Latham Lodge Nursing and Residential Care Home DS0000011509.V287645.R01.S.doc Version 5.1 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 28 and 29 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff at the home are well trained, supported and employed in sufficient numbers to meet the residents needs. There are satisfactory recruitment procedures that ensure residents are not put at risk. EVIDENCE: The residents spoken with described the staff as ‘caring, friendly, helpful and around when you need them.’ Several residents stated that the staff were always polite and had no complaints. Most of the residents spoken with stated that they were happy at the home though one resident preferred to be in his own home. All the residents and relatives spoken with said there was sufficient staff around and that the staff know what they are doing. The rotas showed that a minimum of two registered nurses and eight carers in the morning. One registered nurse and seven carers in the evening and one registered nurse and three carers awake each night. These figures exclude management and administrator. The rota shows a mix of experience and new staff and the manager confirmed that all staff are over eighteen years of age. This was confirmed in the written information provided by the home for this visit. The home also employs two cooks and two kitchen assistants, two cleaners, two laundry assistants and a maintenance man. The staff spoken with felt there was a good skill mix within the staff team and they worked well Latham Lodge Nursing and Residential Care Home DS0000011509.V287645.R01.S.doc Version 5.1 Page 22 together as a team. The staff asked had received a copy of the General Social Care Council’s code of practice and extra codes were available in the office. The staff rotas showed that there are six permanently employed and two bank registered nurses. These registered nurses are responsible for maintaining their own professional updating and those spoken with stated that the home supports them to keep up dated. The manager and administrator confirmed that they regularly check the nurses’ professional registration numbers to ensure that they are renewed when required. The manager confirmed that they are working towards increasing the number of carers with qualifications in care. Currently due to staff leaving only 22 of carers hold a qualification in care. Out of the eighteen carers employed by the home one has a National Vocational Qualification (NVQ) level two in care and three NVQ three in care. The manager confirmed that there is another NVQ level two in care course starting in May 2006 and several carers will be attending. On speaking to carers there appeared to be some confusion as to how the home would support them to complete their qualifications. The carers thought that the home would not pay for their time-spent training. This was discussed with the managers who explained that the home had recently introduced a training contract. This detailed if a carer leaves the employment of the organisation within eighteen months of achieving their qualification in care then a percentage of the cost of training would be paid back. The managers stated they would reassure carers and go through the contract again to ensure they are clear that the home will support them to achieve their qualifications in care. The staff spoken with felt that the recruitment process within the home is thorough. The inspector was able to see four different staff records and found that they were detailed with the necessary checks taken to ensure staff are fit to work at the home. However, one file had only one reference on file. This was discussed with the managers and administrator who stated that the second reference was received and found to be satisfactory, they all remembered read the reference. It was felt that during the recent organisation’s quality monitoring checks for recruitment practices, the reference may have been miss filed. The staff member stated that to her knowledge two references were received. The home has a system for auditing and monitoring their recruitment process that is reported to the commission through regulation 26 reports. Other records seen on file include signed contract of employments, job descriptions and criminal record bureau and protection of vulnerable adults register checks. One of the files seen had a record of the investigation into a gap in employment history for the individual, which showed that the home had been proactive. Latham Lodge Nursing and Residential Care Home DS0000011509.V287645.R01.S.doc Version 5.1 Page 23 The inspector was able to speak with this nurse who explained the process for identifying training needs of individual workers and planning the training programmes for all staff as this was her responsibility. The records of training completed and planned throughout the years were seen and found to be detailed. The staff spoken with stated that the induction programme run by the home was useful and detailed. The files seen held records of the individual staff induction training covering the key areas with the signatures of the staff member and trainer. The training nurse confirmed that the home utilises the organisation’s induction pack and each new member of staff also undertakes an orientation induction specific to the home. The manager and trainer confirmed that the organisation’s induction programme meet the recently amended Skill For Care standards for induction. The home’s training records shows that external and internal training is done, utilising specialist skills and qualifications within the organisation. The staff confirmed that they undertake training regularly and the inspector viewed copies of individual staff training certificates and other records of instructions. The staff have received training in the necessary health and safety subjects such as fire safety, first aid, moving and handling, health and safety, infection control and food hygiene. Other training courses attended by staff include risk assessment, dementia, palliative care, pressure sores, catheter care, wound management, equipment training and principles of care. Latham Lodge Nursing and Residential Care Home DS0000011509.V287645.R01.S.doc Version 5.1 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is now being run well by an experienced manager who is temporarily at the home. There is a good system for involving residents in the day-to-day running of the home and an appropriate, fully auditable quality assurance system. There is a satisfactory system in place for the safe storage and monitoring of residents money. The residents’ health, safety and welfare are well promoted by the home with systems that ensure everyone is protected within the home. EVIDENCE: Currently there is no registered manager at the home. The staff and management explained that the home has undergone a period of unsettlement because the manager recruited a few months ago had left while still on probation. This prompted the organisation to place a senior manager at the Latham Lodge Nursing and Residential Care Home DS0000011509.V287645.R01.S.doc Version 5.1 Page 25 home on a temporary basis until the new manager is recruited and settled in so the service is not further effected and can be improved. The manager is very experienced in the management of nursing homes and is a registered nurse. The staff spoken with stated that since the manager’s arrival the home has felt more settled, they feel supported and things are getting done. The home has recently employed a Head of Care Nurse that works closely with the manager to provide a well-managed service. The staff spoken with confirmed that there is a clear line of authority within the home. The home has a positive supportive ethos and staff training with a programme of one to one monthly supervisions that has recently been restarted, annual appraisals and various staff meetings that are minuted. The residents stated that their family or financial appointees rather than the home look after their money. However, the manager confirmed they do hold for safe keeping residents spending money in the homes safe. The home has records of the money in, out, receipts and balances for each resident whose money they look after. The money is separately stored in individual envelopes. The manager and administrator counted the money for one resident out in front of the inspector and the balance was found to be accurate including receipts and records. The manager explained that he was not an appointee for any client. All the staff, residents and relatives spoken with found the management very pleasant supportive and approachable. Regular risk assessments are undertaken and recorded to ensure that the safety within the home room by room. These were sampled and found to be satisfactory. The managers explained the formal quality assurance process that feeds into the home’s development plan for the year. All systems within the home are audited annually. However, some tasks are monitored and audited daily, weekly, monthly, quarterly and six monthly. The records were seen by the inspector and found to be satisfactory. The staff spoken with were aware of the audit process. The residents spoken with stated that they felt their opinions were valued within the home and some participate in the residents’ meetings. The staff felt they were included in the day-to-day decision making within the home, stating that changes and or issues are discussed and actions agreed at regular staff meetings that are minuted. The minutes were available from the offices for reference. The manager shared with the inspector the quality survey questionnaires completed by residents, relatives, friends and health and social care professionals. These were found to be positive in the main, issues identified Latham Lodge Nursing and Residential Care Home DS0000011509.V287645.R01.S.doc Version 5.1 Page 26 were followed through and resolved. A brief summary of the outcomes is sent to all residents and relatives and representatives. The residents commented on the comings and goings of the home’s maintenance man. Records were sampled of maintenance undertaken on all equipment within the home. All the residents and relatives spoken with stated that they felt safe at the home and some confirmed that the fire alarms are regularly tested. The manager explained the recording system for fires safety maintenance, training, evacuation and visual checks. The visual checks of all fire safety equipment has been recorded and undertaken at appropriate intervals to ensure the safety of the residents. The home has a satisfactory reference file for the Control of Substances Hazardous to Health (COSHH) information leaflets for each chemical being utilised within the home. There are various copies around the home one for the cleaners, the kitchen and the main file held in the office. Latham Lodge Nursing and Residential Care Home DS0000011509.V287645.R01.S.doc Version 5.1 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Latham Lodge Nursing and Residential Care Home DS0000011509.V287645.R01.S.doc Version 5.1 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP88 Regulation 12(1) 17(1) Schedule 3(m) 13(2) 17(1 a, b) Schedule 3(i) Requirement The registered person must ensure that the health needs of individual residents are met and clearly documented. (This requirement remains outstanding from 15/12/05) The registered person must ensure that records for the administration medication is undertaken as per the home’s policy and procedures. (This requirement remains outstanding from 31/10/05) Timescale for action 31/05/06 2 OP99 31/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Latham Lodge Nursing and Residential Care Home DS0000011509.V287645.R01.S.doc Version 5.1 Page 29 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Latham Lodge Nursing and Residential Care Home DS0000011509.V287645.R01.S.doc Version 5.1 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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